Imperial College researchers have pioneered the implementation of therapeutic hypothermia to improve survival of babies following reduced oxygen at birth (perinatal asphyxia). In severe cases, up to 50% of babies with birth asphyxia will die, and as many as 80% of those babies that survive will go on to develop long-term complications, like cerebral palsy. Cooling therapy offers babies the first real treatment to combat the cascade of brain damage that occurs in the hours and days after experiencing birth asphyxia.

Imperial researchers led the TOBY trial to examine the effects of total body cooling for 72 hours in babies with perinatal asphyxia. The study provided evidence that neural rescue is possible after birth asphyxia, with hypothermia providing a simple, cost-effective treatment. The trial demonstrated that infants cooled had an increased rate of survival without neurologic abnormality. This work has saved lives, reduced disabilities, and influenced health policy and healthcare provision worldwide.

Data from the clinical trials of hypothermia and the National Register indicate that as a result of cooling 100 fewer infants annually develop cerebral palsy due to birth asphyxia. Since the inception of the TOBY Register, it is estimated that there has been a cost saving to the health economy of about £150M.

This Imperial research has also lead to national and international changes in healthcare policy and practice. Nationally, the TOBY register clinician’s handbook provides practical guidelines to the selection of infants and their clinical management and is widely used. Nationwide surveys modelled on the UK Register have been carried out in Switzerland and Japan. International guidelines and clinical protocols have been changed for example the American Heart Association (AHA) & American Academy of Paediatrics (2010) now recommends “Therapeutic hypothermia (whole body or selective head cooling)” based on the Imperial research.

For further detailed information, please see the full impact case study at Cooling Babies Limits Brain Injury (PDF).